Provider Demographics
NPI:1396795605
Name:NGOC-HA THI NGUYEN MD PC
Entity type:Organization
Organization Name:NGOC-HA THI NGUYEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOC HA
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-642-3220
Mailing Address - Street 1:PO BOX 1645
Mailing Address - Street 2:
Mailing Address - City:ANNANDAUE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-642-3220
Mailing Address - Fax:703-778-9863
Practice Address - Street 1:7202C POPLAR ST
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-642-3220
Practice Address - Fax:703-778-9863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA490895OtherMEDICARE PTAN
VA5852340Medicaid
490895Medicare PIN
VA490895OtherMEDICARE PTAN